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Evaluating the potential impact of an emergency department extracorporeal resuscitation (ECPR) program: a health records review

Published online by Cambridge University Press:  02 March 2020


Laura McDonald
Affiliation:
Faculty of Medicine, University of Ottawa, Ottawa, ON
George Mastoras
Affiliation:
Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON
Michael Hickey
Affiliation:
Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON Division of Critical Care, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON
Bernard McDonald
Affiliation:
Division of Cardiac Anesthesia, Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON
Edmund S.H. Kwok
Affiliation:
Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON
Corresponding
E-mail address:

Abstract

Objectives

Extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest (ECPR) is an emerging resuscitative therapy that has shown promising results for selected patients who may not otherwise survive. We sought to identify the characteristics of cardiac arrest patients presenting to our institution to begin assessing the feasibility of an ECPR program.

Methods

This retrospective health records review included patients aged 18–75 years old presenting to our academic teaching hospital campuses with refractory nontraumatic out-of-hospital or in-emergency department (ED) cardiac arrest over a 2-year period. Based on a scoping review of the literature, both “liberal” and “restrictive” ECPR criteria were defined and applied to our cohort.

Results

A total of 179 patients met inclusion criteria. Median age was 60 years, and patients were predominantly male (72.6%). The initial rhythm was ventricular tachycardia/ventricular fibrillation in 49.2%. The majority of arrests were witnessed (69.3%), with immediate bystander CPR performed on 53.1% and an additional 12% receiving CPR within 10 minutes of collapse. Median prehospital time was 40 minutes (interquartile range, 31–53.3). Two-thirds of patients (65.9%) were identified as having a reversible cause of arrest and favorable premorbid status was identified in nearly three quarters (74.3%). Our two sets of ECPR inclusion criteria revealed that 33 and 5 patients (liberal and restrictive criteria, respectively), would have been candidates for ECPR.

Conclusion

At our institution, we estimate between 6% and 40% of ED refractory cardiac arrest patients would be candidates for ECPR. These findings suggest that the implementation of an ECPR program should be explored.


Résumé

RésuméIntroduction

La réanimation extracorporelle (REC) dans les cas d'arrêt cardiaque réfractaire est une toute nouvelle technique de réanimation qui a donné des résultats prometteurs chez certains patients qui autrement n'auraient peut-être pas survécu à l’événement. L’étude visait donc à cerner les caractéristiques des patients ayant subi un arrêt cardiaque et ayant été transportés dans l’établissement des auteurs, et à évaluer la faisabilité d'un programme de REC.

Méthode

Il s'agit d'un examen rétrospectif de dossiers médicaux de patients âgés de 18 à 75 ans, qui ont été transportés à l'hôpital d'enseignement désigné et qui avaient subi, sur une période de 2 ans, un arrêt cardiaque réfractaire, d'origine non traumatique, en milieu extrahospitalier ou au service des urgences (SU). Après un examen de délimitation de la documentation, des critères « élargis » et des critères « restrictifs » de REC ont d'abord été établis, puis appliqués à la cohorte de patients.

Résultats

Au total, 179 patients respectaient les critères de sélection. L’âge médian était de 60 ans, et les sujets étaient en grande partie des hommes (72,6%). Dans 49,2% des cas, le rythme initial était de la TV ou de la FV. La majorité des arrêts cardiaques se sont produits en présence de témoins (69,3%); dans 53,1% des cas, la RCR a été pratiquée immédiatement par des spectateurs et, dans 12% de cas supplémentaires, dans les 10 minutes suivant l'effondrement de la personne. Le temps médian avant l'arrivée à l'hôpital était de 40 minutes (intervalle interquartile : 31-53,3). Une cause réversible d'arrêt cardiaque a été mise en évidence chez les deux tiers des patients (65,9%) et un état morbide favorable préexistant, chez presque les trois quarts (74,3%) des patients. Enfin, 33 sujets et 5 sujets auraient été candidats à la REC, selon le type de critères appliqués (élargis ou restrictifs, respectivement).

Conclusion

De 6% à 40% des patients traités pour un arrêt cardiaque réfractaire au SU auraient été candidats à la REC, dans l’établissement où a été réalisée l’étude. Les résultats obtenus donnent à penser qu'il serait justifié d'examiner la mise sur pied d'un programme de REC.


Type
Original Research
Copyright
Copyright © Canadian Association of Emergency Physicians 2020

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References

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McDonald et al. supplementary material

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